With Antidepressant Prescriptions Skyrocketing in the United States, it creates a unique debate for women – who to listen to? Their Psychiatrist or OB/GYN?

The incidence of depression has increased drastically over the past few decades. Women are more prone to develop depression due to several factors that are common as well as completely independent of the causative factors in men. 

The mounting job pressure, demands of career and family responsibilities, commuting to workplace, academic failures, loss of near ones, and an unpleasant event in life are the factors that can make men as well as women prone to develop depression.

Factors such as postpartum depression and premenstrual syndrome occur specifically in women resulting in mild to severe depression.

Since these conditions tend to occur during the reproductive years, it is likely that women would have to use antidepressants prescribed for relieving depression together with birth control pills. 

Hence, there is a need to understand how birth control pills and antidepressants interact with each other and whether it is safe to use both these medications at the same time.

Why is it important to understand the interactions between birth control pills and antidepressants?

Generally speaking, most antidepressants do not interact with the action of oral contraceptive pills, also called birth control pills. For example; wo

men who are using hormonal contraceptives may be prescribed an antidepressant like Prozac if they suffer from symptoms such as extreme mood changes, lack of interest in daily activities, and so on. 

Prozac is a type of antidepressant containing fluoxetine, a selective serotonin reuptake inhibitor (SSRI).

In this case, Prozac may not interfere with the action of the birth control pills causing pregnancy. However, this doesn’t mean it is safe to use these medications together. Because the combined action of the two may potentially cause drastic changes in the mood. 

Antidepressants like Prozac are known to affect the production and release of hormones in the body. And since birth control pills are comprised of synthetically prepared female reproductive hormones like progesterone and estrogens, the risk of interaction between these medicines can not be ignored. 

Similarly, there are a number of antidepressants each having the potential to alter the body’s physiological processes and the hormonal balance. Hence, women in reproductive age who use birth control pills need to be aware of how these antidepressants can affect the action of their contraceptive pills in order to avoid side effects and prevent the reduced effectiveness of both. 

Birth control pills and antidepressants

As discussed earlier, women are likely to develop depression due to a number of reasons. Biological, relationships, lifestyle, psychosocial factors, pregnancy, childbirth, and breastfeeding are the factors unique to women and thought to contribute to their higher risk of depression.

The hormonal changes occurring in the body before and during menses can result in a condition called premenstrual syndrome or PMS. The common signs and symptoms of PMS include mood changes, irritability, heaviness in the breasts, abdominal pain, and cramps in legs. 

In some cases, the symptoms are so severe that they prevent the woman from carrying out routine activities. Women who experience severe symptoms of PMS are often advised to use antidepressants. 

However, these drugs may worsen mood swings and irritability and even cause a failure of the contraceptive pills they are using. Also, the continuous use of antidepressants may not be appropriate or necessary in such cases as the symptoms tend to occur only before and during menstrual periods. These factors must be taken into consideration before women start using antidepressants to manage PMS while also using birth control pills. 

Similarly, women may also experience severe postpartum depression following childbirth due to the hormonal changes occurring in the body during this phase as well as the sudden lifestyle changes and challenges posed by motherhood. 

Breastfeeding itself acts as a natural method of contraception during the initial few months after delivery when the mother is breastfeeding the child. However, once the woman stops breastfeeding, she may need to use birth control pills to avoid pregnancy until she feels she is ready for the second child. 

In this case, it is important to be aware of the interactions between the antidepressant she is using and the birth control pills, especially if the symptoms of postpartum depression are severe necessitating long-term use of the antidepressant drug.

Similarly, there are various other situations when women of reproductive age may have to use birth control pills and antidepressants together. This is why; women should take efforts to find out how these drugs affect each other’s actions, alter their effectiveness, or cause side effects. 

Use of birth control pills, and antidepressants for PMDD

PMDD or premenstrual dysphoric disorder is a condition similar to PMS. In fact, PMDD is a more intense form of typical premenstrual syndrome. The common signs of this condition are severe anxiety, extreme irritability, and drastic mood swings. 

Women who have a history of postpartum depression or mood disorders are prone to develop premenstrual dysphoric disorder. 

PMDD is often confused with depression as both these conditions cause similar symptoms such as sadness, despair, increased sensitivity to criticism, suicidal thoughts, and so on. The use of antidepressants is common in women with PMDD. However, it should be noted that the symptoms of PMDD are linked to the hormonal changes typically occurring around ovulation and before periods.  

Hence, the use of antidepressants may not be appropriate in such cases, especially if the woman is already using birth control pills and wishes to avoid pregnancy. 

It has been found that most women find remarkable relief in their symptoms of PMDD by simply using birth control pills. The use of oral contraceptives has been found to work more effectively than antidepressants in reducing the symptoms of PMDD as well as in some cases of PMS. Let us have a look at how birth control pills could help to relieve PMDD. 

Most birth control pills contain synthetic versions of female reproductive hormones called estrogens and progesterone. These hormones help to prevent conception by inhibiting the process of ovulation. These pills also provide the body with a steady dose of estrogens without any peaks or drastic fluctuations. This action helps to prevent the release of eggs by the ovaries. 

Later, oral contraceptive pills start delivering a fixed amount of progesterone to stop the growth of the uterine lining called endometrium. Finally, most birth control pills have a 7-day dosage schedule of placebos, which cause the hormonal levels to fall resulting in your periods to start. 

The menstrual flow that begins during the use of placebo pills is a withdrawal bleeding caused as a reaction to the lack of supply of hormones. This is the basic action by which most birth control pills help to prevent pregnancy.

Since these pills deliver estrogens and progesterone in steady doses, they can make the hormone levels in your body more predictable thereby controlling the symptoms caused due to hormonal imbalances.

For example; cramps in the legs and abdomen caused due to PMS or PMDD may be relieved by using oral contraceptives. These pills work by controlling the production of prostaglandin, which is responsible for causing excessive uterine contractions.

Also, mood swings, depression, and anxiety caused due to the fluctuations in the levels of hormones can also be relieved by the steady release of estrogens and progestogen achieved through the use of oral contraceptives. 

This points to the need to avoid or minimize the use of antidepressants and instead, use only birth control pills to relieve PMDD and PMS while preventing conception. This strategy can also allow women to avoid the side effects of antidepressants known to occur due to their prolonged usage.  

This is one of the reasons why the simultaneous use of birth control pills and antidepressants is not recommended. In some cases, it could worsen the side effects of antidepressants; in some cases, it may lessen the effectiveness of birth control pills; and in some cases, it may be unnecessary.

Can antidepressants lower the effectiveness of birth control pills?

Antidepressants like SSRIs may interfere with the action of glands that produce hormones in the body. This could alter the levels of estrogens and progesterone in women. Antidepressants can also alter the bioavailability or the amount of circulating hormones in the body. 

The fluctuating levels of estrogens and progesterone due to the use of antidepressants can, thus, change the balance of female reproductive hormones thereby lowering the effectiveness of oral contraceptive pills. This can not just result in a few side effects associated with hormonal imbalances but may also lead to an unintended pregnancy.

Some women may also experience increased mood swings and irritability as side effects of the hormonal medications. Hence, if women find exacerbations in their symptoms of depression, PMS, or PMDD, it could be attributed to the interactions between antidepressants and birth control pills. A change in the antidepressant or the birth control pill, in such cases, may alleviate the symptoms. 

However, the way antidepressants alter the action of oral contraceptive spills varies among women. There are differences in the levels of estrogens and progesterone from woman to woman. At the same time, the way the compounds in antidepressant drugs are metabolized in the body can also change depending on the specific health issues or metabolic rate and dysfunctions in different women. 

These factors need to be taken into consideration while determining how the antidepressants can alter the action and effectiveness of oral contraceptives. In some women, the use of antidepressants may cause a bigger drop in the effectiveness of birth control pills while in some, it may not interfere with each other’s actions much. 

The use of anti-seizure medications

Anti-seizure mediations, as the name suggests, are prescribed to women who suffer from seizures or convulsions. However, the use of these drugs is not limited to seizures. 

Most women with depression are also prescribed anti-seizure drugs. It is important to mention that these drugs are known to decrease the effectiveness of oral contraceptive pills. For example, anti-seizure medications like Lamotragene, Tegretol, and Topomax, which are commonly prescribed to treat depression or stabilize bipolar disorder, can affect the hormonal balance in the body resulting in the failure of oral contraceptives. 

Hence, women suffering from depression or seizures should inform the physician about the use of oral contraceptives and their desire to avoid pregnancy so that appropriate medications can be prescribed to them. 

In case anti-seizure drugs must be prescribed to relieve severe depression, it is best to adopt additional measures of contraception such as condoms or diaphragms in combination with oral contraceptive pills to avoid pregnancy. 

Can birth control pills trigger depression?

Most women are concerned about mood changes and depression that may occur due to the use of birth control pills. Not just oral contraceptive pills but also the other hormonal birth control methods such as the patches, implants, rings, injections, and IUDs have been reported to have caused depression in some women.

The rising cases of depression associated with the use of these hormonal medications have led to several research studies.

Most of these studies have not shown any definitive association between the use of hormonal methods of contraception and depression. In fact, a critical review of these studies has revealed that the overall percentage of women that can develop depression due to hormonal contraception was very small. 

It has been found that just 2.2% of women who used hormonal contraception developed depression in comparison to 1.7% who did not. These findings suggest that only some women could be susceptible to this side effect. 

Hence, women need not avoid adopting hormonal birth control methods for the fear of developing depression. On the contrary, the hormonal balance achieved through the use of oral contraceptive pills has been associated with relief from the existing symptoms of depression. 

The mood-stabilizing action of birth control pills is so effective that it may help women avoid the use of antidepressants known to cause serious side effects. 

The Bottom Line

Birth control pills and antidepressants have a complicated relationship. The type of antidepressant or oral contraceptive used, the body composition, and stages in the menstrual cycle need to be considered to evaluate the possible interactions between these drugs. 

Women must seek the advice of a gynecologist and psychiatrist and inform them of the medications they are already using and their intentions to avoid conception so that the physicians can recommend appropriate treatments. 

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antidepressants, Prozac, postpartum depression, premenstrual syndrome, bi-polar, borderline, seasonal affect disorder, psychiatrist, birth control, obgyn, women’s ealth, pregnancy prevention

 With Anti-Depression Prescriptions Skyrocketing in United States, it creates a debate for women – who to listen to? Their Psychiatrist or OB/GYN?

Is it safe to take birth control pills and antidepressants at the same time?